2014 KidSport Individual Equipment Application

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Oct 9, 2013 ... Please make sure all equipment needed is listed on provided pages, along ... Individual Equipment Application to the KidSport™ Fund.
Application for Equipment for Individuals

APPLICATION CHECKLIST  All blanks in Steps 1 and 2 are filled in and complete.  Please make sure all equipment needed is listed on provided pages, along with detailed sizing needs.

 I am aware that I am responsible for any and all shipping costs associated with receiving the equipment.

Administered by

Corporate Sponsor

Individual Equipment Application to the KidSport™ Fund The KidSport™ Fund is a national charity created to assist children from financially disadvantaged families to enter into sport programs where they can develop life skills such as fair play, leadership and teamwork. In Manitoba, KidSport equipment is collected and distributed by the Manitoba Aboriginal Sport and Recreation Council in partnership with Sport Manitoba. The amount and type of equipment collected is limited. Please consider your equipment needs carefully before submitting this application. Be aware that the fulfilment of your application will depend on equipment availability. Incomplete applications will not be considered. Please read the following guidelines carefully before completing this form.

FUNDING POLICIES A) Equipment grants to individual athletes are designed to help those who would not play a sport without KidSport’s help and will be provided if equipment is available, on a first come first serve basis. B) KidSport assists children aged 18 and under, with preference given to kids trying a sport for the first time C) KidSport will contact the recipient to collect his/her equipment. In Winnipeg, the recipient is responsible for picking up the equipment at the location indicated by Kidsport. In all other locations, the equipment will be shipped to the closest bus depot/drop-off location. The local bus depot will contact the recipient who is then responsible for picking up the equipment. D) Equipment is previously used and will be distributed as is.

DEADLINE: No Application Deadline – Subject to Availability of Equipment

Individual Equipment Application to the KidSport™ Fund STEP 1

CHILD INFORMATION

Child’s Last Name:______________________________

First Name: _______________________________

Address: ________________________________________________________________________________ City: _________________________________________ Male

Female

Age _____

Postal Code: ______________________________

Birth Date: Year _______

Month _______ Day _______

Sport Child will be Participating in: ___________________________ Number of Years in Sport: __________ Sport Organization: ________________________________________________________________________ General Information Age: ___

STEP 2

Height: _______

Weight: ______

Clothing Size: _____

Jacket Size: _____ Shoe Size: ____

PARENT / SPONSOR / GUARDIAN INFORMATION

Note: The parent/guardian/sponsor will act as the contact person for the child & will receive all correspondence.

Last Name: ___________________________________

First Name: _______________________________

Address (if different from Child’s): ___________________________________ Postal Code: __________________ Telephone: (Home) ___________________ (Work) _____________________ (Cell) ____________________ E-mail: ___________________________________________________ Fax: _________________________ Relationship to Child (i.e. Parent/Sponsor/Guardian/other): ________________________________________________

STEP 3

EQUIPMENT SELECTION

Region:

Last Name:

If possible, please try on equipment (ex: a teammates, at a store) to ensure correct sizes. HOCKEY / RINGETTE / IN-LINE HOCKEY (please circle correct sport) Youth

Junior

Senior

-Helmets

-Sm.

-Med.

-Lg.

-Sm.

-Med.

-Lg.

-Sm.

-Med.

-Lg.

-Shoulder Pads

-Sm.

-Med.

-Lg.

-Sm.

-Med.

-Lg.

-Sm.

-Med.

-Lg.

-Elbow Pads

-Sm.

-Med.

-Lg.

-Sm.

-Med.

-Lg.

-Sm.

-Med.

-Lg.

-Glove

-Sm.

-Med.

-Lg.

-Sm.

-Med.

-Lg.

-Sm.

-Med.

-Lg.

-Pants

-Sm.

-Med.

-Lg.

-Sm.

-Med.

-Lg.

-Sm.

-Med.

-Lg.

-Shin Pads

Yth. ______ inches

-Skates

Size _________ (usually one size lower than your running shoes)

-Stick

Jr. ______ inches

-Left

Sr. ______ inches

-Right

* Goalie equipment may be available upon request.

SOCCER -Shoes

____________ (same size as your running shoes)

-Shin Pad Size

Junior

-Small

-Medium

-Large

Senior

-Small

-Medium

-Large

-Shorts

Junior

-Small

-Medium

-Large

Senior

-Small

-Medium

-Large

-Jersey

Junior

-Small

-Medium

-Large

Senior

-Small

-Medium

-Large

-Ball

-Size 3 (3-8 Yr. Olds)

-Size 4 (9-12 Yr. Olds)

-Size 5 (13 Yrs. & Up)

GOLF -Shoes -Clubs

____________ (same size as your running shoes) -Left

-Right

BASEBALL / SOFTBALL -Bat

Junior __________ inches

Senior __________ inches

-Glove

Junior

-Small

-Medium

-Large

Senior

-Small

-Medium

-Large

-Helmet

Junior

-Small

-Medium

-Large

Senior

-Small

-Medium

-Large

-Cleats

____________ (same size as your running shoes)

CATCHER’S EQUIPMENT -Shin Pads

Junior __________ inches

Senior __________ inches

-Mask

Junior

-Small

-Medium

-Large

Senior

-Small

-Medium

-Large

-Glove

Junior

-Small

-Medium

-Large

Senior

-Small

-Medium

-Large

-Belly protector

Junior

-Small

-Medium

-Large

Senior

-Small

-Medium

-Large

STEP 4

EQUIPMENT SELECTION

Region:

Last Name:

OTHER EQUIPMENT Please list all items you require. Equipment will not be disbursed if it is not listed below. Please be as specific as possible with all sizes.

Item requested ____________________________________________

Size requested ________________

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For Sport Manitoba Office Use Only Name: _______________________________________ Region: ____________________________________________ Signature: ____________________________________ Date: ______________________________________________

WHERE DO I MAIL OR FAX THE FORM? Sport Manitoba - Central Region 225 Wardrop Street, Morden MB, R6M 1N4, 204-822-6735 (Fax) – 204-822-2915

Sport Manitoba - Eastman Region Box 50, 20 – 1st Street, Beausejour MB, R0E 0C0, 204-268-2172 (Fax) – 204-268-6070

Sport Manitoba - Interlake Region Box 1519, 62-2nd Avenue, Gimli MB, R0C 1B0, 204-642-6015 (Fax) – 204-642-6080

Sport Manitoba - Norman Region PO Box 564, Thompson MB, R8N 1N4, 204-778-3109 (Fax) –204-677-7925

Sport Manitoba - Parkland Region 27-2nd Avenue S.W., Dauphin MB, R7N 3E5, 204-622-2094 (Fax) – 204-638-6558

Sport Manitoba - Westman Region Room 335, 340-9th Street, Brandon MB, R7A 6C2, 204-726-6072 (Fax) – 204-726-6583

Sport Manitoba - Winnipeg Region 145 Pacific Avenue, Winnipeg MB, R3B 2Z6, 204-925-5922 (Fax) – 204-925-5638

Questions? Call the KidSport™ Toll Free Line at 1-866-774-2220.